Influence of ozone on caries incidence around orthodontic brackets"

Objectives: To assess, using ICDAS II, a photographic method and DIAGNOdent, the ability of ozone or air treatment to prevent white spot carious lesions around orthodontic brackets in permanent teeth in-vivo in a double blind clinical trial. Methods: Forty patients participated in this study. A split mouth technique was implemented to examine the upper labial/buccal, where one side (left or right) was randomly allocated to the ozone treated group, and the other side served as a control which was treated with air. The air or ozone were applied by a second operator who was not involved with the caries detection scoring. After bracket bonding, DIAGNOdent readings, digital photographs and enamel scoring for decalcification (using ICDAS II) were taken and ozone or air were applied from the HealOzone unit (KaVo) for 10 seconds around each bracket at baseline, 3, 6 and 9 months. At 12 months, all the assessment measures, without ozone or air application, were repeated. Results: The number of teeth with white spot lesions at the end of the treatment, using the photographic assessment, was 41 (28.5%) for the control air group and 13 (9%) for the ozone group (p = 0.006, p < 0.05). There was a significant effect of time upon the mean DIAGNOdent readings and ICDAS II scores between ozone group and air group (P < 0.05). The Spearman's rank correlation coefficient between the changes in the DIAGNOdent and the ICDAS II scores over the recall visits was 0.75. Conclusions: White spot lesion formation associated with fixed orthodontic treatment can be assessed using the ICDAS II, DIAGNOdent and a photographic method. Ozone treatment was capable of significantly reducing white spot lesion formation around orthodontic brackets. This adds new knowledge for the orthodontist with regard to ozone treatment as a part of orthodontic therapy in order to reduce the incidence of carious lesions around orthodontic brackets.